Parents' Underestimations of Child Weight: Implications for Obesity Prevention

Healthy Change Intervention: A Cluster RCT in Preschooler Mothers in Mexico and the United States

OBJECTIVE

To assess effects of Healthy Change intervention on maternal perception of her child's body weight (MPCW), maternal feeding style, and obesogenic home environment.

METHODS

A randomized control trial was conducted, consisting of two arms: the intervention group received the Healthy Change program, and the control group received the Hygiene and Accident Prevention program. A total of 356 mother-preschool child dyads participated, 182 in the intervention group and 174 in the control group, residing in Mexico and the United States. Data were collected at baseline and after the program through self-administered questionnaires completed by mothers and child anthropometric measurements.

RESULTS

Although no significant between-group difference in pre- and post-intervention change of MPCW was found, sub-analyses revealed that a higher proportion of mothers in the intervention group accurately perceived their child's body weight at the study endpoint using categorical (67% vs. 57.1%, p < 0.005) and visual scales (48.9% vs. 41.8%, p < 0.015). Additionally, more mothers of overweight children in the intervention group accurately perceived their children's overweight and obese status compared to those in the control group (29.8% vs. 10.3%, X2 = 4.26, df = 1, p < 0.039). The intervention group also displayed a higher proportion of mothers with authoritative feeding style (26.4% vs. 16.5%, p < 0.036) and significantly higher family nutrition and physical activity scores (29.1 vs. 28.0, p < 0.000) at the study endpoint.

CONCLUSIONS FOR PRACTICE

Healthy Change Intervention led to improved accuracy of MPCW, a shift toward maternal authoritative feeding styles, and positive changes in obesogenic home environments.

The Family Nutrition and Physical Activity Survey: Comparisons with Obesity and Physical Activity in Adolescents with Autism Spectrum Disorder

Adolescents with autism spectrum disorder (ASD) are at a heightened risk for obesity. Family-level measures of nutrition and physical activity may help explain factors contributing to disproportionate rates of weight gain. Twenty adolescents with ASD participated in baseline testing for a study to assess the feasibility of remotely-delivered yoga. Parents completed the Family Nutrition and Physical Activity (FNPA) survey and anthropometrics and physical activity were assessed in the adolescents. A median split was applied to the FNPA score to create high and low obesogenic environments and nonparametric O'Brien's multiple endpoint tests were used to evaluate the differences. Between-group differences were found in anthropometrics (p = 0.01) but not physical activity (p = 0.72). Implications for a multifaceted family-based approach to obesity prevention are discussed.

Knowledge, Attitudes, and Behaviors towards Proper Nutrition and Lifestyles in Italian Diabetic Patients during the COVID-19 Pandemic

Prevention of diabetes mellitus is mainly based on a healthy lifestyle. The lockdown measures imposed during the COVID-19 pandemic resulted in major changes in daily life and social behavior, which may have an influence on diabetes self-management and glycemic control. The present work aims to assess the relationship between diabetic patients' knowledge, attitudes, and behaviors towards proper nutrition and lifestyles in order to plan strategies for educational intervention from a health literacy perspective. Attitudes, behaviors, and knowledge of diabetic patients attending the Diabetes and Metabolic Diseases Department of the Local Health Authority of Sassari (ASL1-SS) were assessed with a cognitive survey conducted from April to July 2022. Three hundred twenty-one questionnaires were administered during the survey period. Fifty-two percent of diabetic patients were female and 48% male, with a mean age of 61.1 ± 18.5 years and 62.0 ± 15.1 years, respectively. The overall level of knowledge about the role of food and proper nutrition with respect to the risk of diabetes and its complications appeared to be generally unsatisfactory and inadequate. Nonetheless, females showed a significantly higher level of knowledge than males (p < 0.0001). Moreover, knowledge was seen to decrease according to the age of the patients (p = 0.035). As for the possible impact played by the COVID-19 pandemic on lifestyles, it should be noted that about 70% of the respondents stated that they had maintained a reasonable dietary standard or even improved it throughout. Thus, the study underlines the need to improve the knowledge of diabetic subjects about nutrition and, in particular, their self-management, positively influencing behaviors and attitudes.

Impacts of an early childhood obesity prevention program in Mexico

The Healthy Change Program aimed to improve the accuracy of maternal perceptions of children's weight (MPCW), maternal feeding style (MFS) and feeding practices. Using a randomized control trial design, the intervention group received 4-weekly group sessions focusing on MPCW, MFS and healthy behaviors. The control group received the same dose of attention-control sessions on food hygiene. Data were collected at the baseline and at the end of the program via self-administered questionnaires and anthropometric measurements. Participants included 294 mother-child dyads with 149 in the intervention group and 145 in the control group. The accuracy of MPCW significantly increased at the study end point in the intervention group (57.0-67.1%, P < 0.05) but not in the control group (67.6-69.7%, P > 0.05), with no between-group difference in pre- and post-change (P > 0.05). At the study end point, more mothers of overweight and obese children in the intervention group had accurate MPCW than their control counterparts (31.4% versus 11.1%, P < 0.01). The intervention group had a shift toward an authoritative style at the study end point (17.4% versus 26.2%, P < 0.001) and favorable changes in feeding practices. The Healthy Change Program contributed to improving the accuracy of MPCW and shifts toward favorable MFS and feeding practices.

Assessment of Actual Weight, Perceived Weight and Desired Weight of Romanian School Children-Opinions and Practices of Children and Their Parents

Objective: Children and parental awareness regarding weight is linked to the development and management of overweight and obesity. The aim of this study is to assess the actual weight, perceived weight, and desired weight of Romanian school children. Methods: A cross-sectional study was conducted in 2019 in seven schools from two counties of Romania and included 880 pupils aged between 10 and 15 years old and 665 parents. We administrated confidential questionnaires to the participants, and we measured children’s weight and height during school activities. Results: A total of 61.0% of pupils had normal weight, 7.4% were underweight, and 31.6% were overweight or obese. A total of 66.7% of normal weight children, 56.5% of overweight children, and 40% of underweight children perceived their weight accurately. Regarding parents, a majority correctly appreciated the weight of their normal weight children and only a third appreciated correctly the body weight of their underweight and overweight children. Factors such as body mass index, gender, weight related behaviors, parents’ estimation about their children’s weight, discussions of weight topics inside family, and bullying, cyberbullying and exclusion from groups were associated with misperceptions. Conclusion: The study provides useful information for health education activities targeting both children and their parents regarding appropriate body weight management of children.

Development and validation of the Child Weight Risk Questionnaire

PURPOSE

The study objective was to develop and validate a measure of parent perception of child weight-related risk, the Child Weight Risk Questionnaire (CWRQ), among a sample of US parents.

METHODS

A cross-sectional survey was conducted in a sample of 216 parents of 6- to 12-year-old children who were overweight. The CWRQ was used to assess parent beliefs about their child's susceptibility to physical, social-emotional, and behavioral health problems due to weight.

RESULTS

Confirmatory factor analysis supported the three-factor structure of the CWRQ and acceptable fit was achieved. The internal consistency of the measure was excellent. Convergent, discriminant, and incremental validity analyses provided initial evidence for CWRQ validity.

CONCLUSION

The CWRQ is a reliable and valid instrument for assessing parent perception of child weight-related risk. This measure could be utilized in research and applied settings to capture the multifaceted nature of parent risk perception and support efforts to tailor family weight interventions in ways that align with parent beliefs.

LEVEL OF EVIDENCE

Level V, cross-sectional, descriptive study.

Prevalence of overweight and obesity among Kuwaiti adolescents and the perception of body weight by parents or friends

Objective

Recently, the State of Kuwait has witnessed a steady rise in the prevalence of obesity among children and adolescents. The present study aims to provide an update on the rate of overweight or obesity among Kuwaiti adolescents and examines the associations between adolescents’ overweight/obesity levels and their perception of body weight as seen by parents or friends.

Methods

A cross-sectional study was conducted in Kuwaiti secondary schools and included adolescents between the ages of 15 and 18 years, using a multistage stratified random sampling method. Body weight and height were measured. A specifically designed self-report questionnaire was used to assess parents’ and friends’ perceptions of an adolescent’s body weight.

Results

A total of 706 adolescents were included the study. The prevalence of overweight or obesity among Kuwaiti adolescents reached nearly 50%, with males (54.3%) having a significantly higher overweight or obesity percentage than females (44.6%). No significant difference in the prevalence of obesity relative to age, from 15 to 18 years, was found. In addition, logistic regression analysis, adjusted for age and gender, revealed that adolescents perceived their parents (p = 0.011 and p < 0.001) or friends (p = 0.002 and p < 0.001) as more likely to classify their weight as overweight or obese, respectively.

Conclusion

Overweight or obesity levels appear to be high among Kuwaiti adolescents, and appears to have reached a plateau recently. Efforts to combat obesity and promote physical activity and healthy nutrition are needed. Future studies should seek to identify important moderators of parental and social underestimation/overestimation of children’s overweight or obesity.

Parental perception of child's weight, their attitudes towards child's dietary habits and the risk of obesity

BACKGROUND

The association between parental perception of child's weight and their attitudes towards his/her dietary habits has not been reported yet. This study aimed to assess the association between parental underestimation of child's weight and parental attitudes towards child's dietary habits.

METHODS

We conducted a cross-sectional analysis of SENDO cohort participants recruited between January 2015 and June 2020. All information was collected through online questionnaires completed by parents. We calculated crude and multivariable-adjusted odds ratio (OR) and 95% confidence intervals (CI) for unhealthy attitudes towards child's dietary habits associated with parental underestimation of child's weight.

RESULTS

Sixteen percent of children in the SENDO project had parents who underestimated their weight. Parents who underestimated their child's weight status were more likely to have unhealthy attitudes toward his/her dietary habits [OR 3.35; 95% CI (1.71-6.53)].

CONCLUSIONS

Parental underestimation of child's weight was associated with unhealthy attitudes towards child's dietary habits. Pediatricians and public health practitioners should pay attention to the parental perception of child's weight to identify parents who underestimate it as an at-risk group in which to inquire about lifestyle and dietary habits.

Health belief model factors as predictors of parental misclassification of the weight of the preschool child

Background

Parental misperception and underestimation of their child’s weight are documented in studies. Demographic factors like age and gender have been linked to misclassification. However, modifiable factors that could potentially frame future intervention and prevention strategies have not been explored. This study aimed to assess factors that could predict parental misclassification of their preschool child’s weight.

Methods

This was a cross-sectional study with 198 parents and their 2- to 5-year-old children who attended standalone preschools or childcare centers with preschools. Parents completed a questionnaire that asked about demographic features, personal and family health, and the assessment of their child’s weight using the three most frequently utilized measures. Logistic regression was conducted to assess the association between parental factors and child weight classification status. Instruments included the Parental Self-Efficacy for Promoting Healthy Physical Activity and Dietary Behaviors in Children Scale (PSEPAD), the Obesity Risk Scale (ORK-10), and the Adolescent Obesity Risk Scale (AORK). Analyses included frequencies, chi-square tests, Kappa coefficients, and logistic regressions.

Results

Parents were least accurate (35.9%) identifying child weight when selecting a picture (κ = -.028, p = .42). The pictorial and Likert method (κ = -.032, p = .37) showed parental agreement with child weight was not significantly better than chance. Statistically, a significant agreement was found in the weight-reporting method (κ = .21). Two of the three HBM-related measures were significantly related to accurate classification. Logistic regression showed child sex, PSEPAD scores, and ORK-10 scores were statistically significant predictors in the Likert method. The model had no statistical significance for the pictorial or weight-reporting method.

Conclusion

Results indicate parents support intervening if aware of child weight problems. However, parents do not accurately recognize healthy versus unhealthy weights and report that health providers are not informing them of weight deviations. Further, important relationships between the HBM variables were identified. Results show barriers (self-efficacy) mediate the impact of perceived severity (knowledge) regarding the parental ability to assess child weight accurately. These relationships and incorporation of the HBM principles of barriers and severity into prevention/intervention strategies need further exploration.

Concordance Between the Weight of Spanish Adolescent Soccer Players, Their Self-Perceived Weight, and Their Weight as Perceived by Their Parents

PURPOSE

In the context of soccer clubs, to analyze the concordance between players' actual weight, their self-perceived weight, and their weight as perceived by their parents; to determine which variables might explain the presence of concordance between parents' perception of adolescents' weight and their actual weight. Design and study: A cross-sectional study involving 330 soccer players aged between 13 and 16. Data on personal characteristics of adolescents and parents were analyzed, as well as parents' perceptions of adolescents' weight status and their self-perception. A descriptive analysis of the personal characteristics of the sample (adolescents and parents) and an analysis of the variables explaining the presence of concordance between the parents' perception of adolescents' weight and their actual weight were performed.

RESULTS

19% of the adolescents were overweight and 3.4% were obese. The concordance between parents' perceptions of players' weight and players' actual weight was weak. The concordance between adolescents' self-perceived weight and their actual weight was moderate. The difference in BMI scores according to presence or absence of concordance was statistically significant: these scores were higher in the absence of concordance. Discordance between adolescents' weight and their parents' perception of their weight was associated with parents having lower levels of education.

CONCLUSION

A high percentage of parents and players misperceived their actual weight. This discrepancy was associated with higher BMI scores for adolescents.

PRACTICE IMPLICATIONS

Nurses should include promotion of accurate weight perception in educational interventions on excess weight.

Paediatric teams in front of childhood obesity: A qualitative study within the STOP project

INTRODUCTION

Understanding the underlying factors that influence the approach to overweight and obesity in children is basic to best support families searching a solution to this important public health problem.

OBJECTIVE

To assess attitudes and feelings of paediatric staff in addressing overweight and childhood obesity to parents, exploring perceived barriers and facilitators, for an effective care.

PARTICIPANTS AND METHOD

Qualitative study by means of individual semi-structured questionnaires of paediatric staff (paediatricians and paediatrician nurses; n = 57; 68% female) of primary health care centres and hospitals in Mallorca. Thematic analysis was done.

RESULTS

Three themes emerged from the data: "Parents' attitude in childhood obesity" (sub-themes "The conscience of parents", "The parents ask for help"), "Paediatric staff and childhood obesity" (sub-themes "Approaching to the problem: The interview with parents", "Looking together for the solution"), and "System barriers" (sub-themes "Improving teamwork and health policy", "Family participation in addressing childhood obesity").

CONCLUSIONS

Paediatric staffs know how to treat childhood obesity, but demand training on motivation. Effectivity on therapy of childhood obesity will be obtained after parents/carers recognize the problem and establish a trustful relationship with paediatric staff. The health system is still a barrier to the activity of paediatric personnel.

Weight Misperception among African American Adolescents: The Jackson Heart KIDS Pilot Study

Background

Weight misperception is a common problem among adolescents; however, few studies have examined contributing factors among an exclusively African American population. The purpose of this study was to examine factors associated with weight misperception among 12- to 19-year-old participants in the Jackson Heart KIDS Pilot Study (JHS-KIDS).

Methods

Data were drawn from JHS-KIDS, a prospective, observational examination of cardiovascular-related risk factors among African American adolescents who were children or grandchildren of participants in the Jackson Heart Study. Adolescent weight misperception - discordance between measured weight status and perceived weight status - was the primary outcome of interest. Self-reported weight control behaviors, parent concerns about adolescents' weight, parent-perceived responsibility for adolescent's weight and daily hassles were the primary independent variables of interest.

Results

The analytic sample was equally divided by females (n=107) and males (n=105) and one third of study participants (33.5%) had discordance between their actual and perceived weight. Results from fully adjusted sex-stratified modified Poisson regression models indicated that weight behavior control was significant among females (PR = .66, 95%CI:1.20-2.30). Parental concerns about child weight were significant for males. Each additional point increase in the parent's concern about their weight score was associated with a 9% increase in the adjusted prevalence of weight misperception among males (95%CI: 1.03-1.16).

Conclusions

The sex-specific patterns in this study highlight heterogeneity among African American adolescents and an urgent need to consider sex and gender when developing targeted interventions for youth who are at high risk for weight misperceptions and unhealthy weight control practices.

Health literacy as a determinant of childhood and adult obesity: a systematic review

OBJECTIVES

To assess whether Health Literacy (HL) acts as a determinant of obesity in adults and children by synthesizing the results of recent scientific evidence.

CONTENT

This is a systematic qualitative review following the MOOSE guidelines. A systematic, computer-assisted literature search via PubMed scientific database, between January 1st, 2000, and September 30th 2020, was conducted. Only cross-sectional epidemiologic research studies that were published in the English language, investigating HL's possible role as a determinant of childhood and adult obesity, were included.

SUMMARY

After screening 725 citations from the PubMed database, 39 (n=39) studies in total were included in this literature review; Four (n=4) studies were conducted in the children population, seven (n=7) studies were performed in children-parent/caregiver dyads, and 28 studies (n=28) enrolled adults. There is significant evidence that HL knowledge and skills determine the consequent management of obesity and BMI rates in children and adult populations.

OUTLOOK

Despite policies and action plans put in place by countries globally, overweight and obesity continue to be a pressing public health issue and one of the critical drivers of non-communicable diseases, constituting a health, social and economic burden worldwide. Health Literacy as an essential health policy and promotion agenda item and a critical empowerment strategy could increase children's and adults' control over their overall health and awareness to overcome obesity issues. Initiatives to improve HL levels could be useful tools in managing the obesity epidemic, starting from integrating HL in the school curriculum and further in family and community action plans.

[Paediatric teams in front of childhood obesity: a qualitative study within the STOP project]

INTRODUCTION

Understanding the underlying factors that influence the approach to overweight and obesity in children is basic to best support families searching a solution to this important public health problem.

OBJECTIVE

To assess attitudes and feelings of paediatric staff in addressing overweight and childhood obesity to parents, exploring perceived barriers and facilitators, for an effective care.

PARTICIPANTS AND METHOD

Qualitative study by means of individual semi-structured questionnaires of paediatric staff (paediatricians and paediatrician nurses; n=57; 68% female) of primary health care centres and hospitals in Mallorca. Thematic analysis was done.

RESULTS

Three themes emerged from the data: «Parents' attitude in childhood obesity» (sub-themes «The conscience of parents», «The parents ask for help»), «Paediatric staff and childhood obesity» (sub-themes «Approaching to the problem: The interview with parents», «Looking together for the solution»), and «System barriers» (sub-themes «Improving teamwork and health policy», «Family participation in addressing childhood obesity»).

CONCLUSIONS

Paediatric staffs know how to treat childhood obesity, but demand training on motivation. Effectivity on therapy of childhood obesity will be obtained after parents/carers recognize the problem and establish a trustful relationship with paediatric staff. The health system is still a barrier to the activity of paediatric personnel.

Parental Factors Associated with Obesity in Korean Adolescents

Parental characteristics can influence adolescent obesity. However, the influence of parental characteristics on obesity may differ depending on the adolescent’s sex. This study evaluated parental characteristics that were associated with obesity in male and female adolescents. This study involved the secondary data analysis of cross-sectional survey data that were collected from June to September 2015. The study subjects included 1621 eighth-grade students. The study variables included sex, age, body mass index, household income, parental weight, parental perceptions of the child’s body, parental lifestyle, and parental social support for healthy eating and physical activity. The association between parental factors and adolescent obesity was analyzed via logistic regression analysis for each sex. Among male students, the fathers’ and mothers’ overweight status, fathers’ underestimation and overestimation of male adolescent weight, mothers’ dietary habits, and the mothers’ physical activity level were identified as obesity-associated factors. Among female students, the mothers’ overweight status, underestimation of female adolescent weight by fathers, dietary habits, and the physical activity level of fathers were significantly associated with adolescent obesity. The mothers’ overweight status and the underestimation of weight by fathers were strongly associated with obesity in male and female adolescents. Parental involvement in obesity-intervention programs could help prevent adolescent obesity.

Intra-familial health polarisation: how diverse health concerns become barriers to health behaviour change in families with preschool children and emerging obesity

In a disadvantaged rural area in Denmark, severe challenges have been identified concerning overweight and obesity in families with preschool-age children. The present paper examines how families with young children and emerging obesity issues perceive 'healthy living' and barriers to practising it. Using data from qualitative workshops with families and professionals working with them, we reveal health perceptions and related family dynamics. Drawing on P. Bourdieu's theory of habitus and 'tastes of necessity', K.L. Frohlich et al.'s notion of 'collective lifestyles' and E. Lindbladh and C. H. Lyttken's theory of preconditions for health behaviour change and reactions to risk-related information, we analyse how risk perceptions and related health practices within the families are influenced by the local contexts in the disadvantaged area under study. Despite shared perceptions of 'healthy living', we found that diverse health-risk perceptions created family dynamics in which parents performed opposed health behaviours, which became a huge barrier to becoming a healthier family. Based on our theoretical approach, we propose that risk perceptions and reactions are highly context dependent, as illustrated in both micro-contexts (family dynamics) and the macro-context (the disadvantaged area).

Development and Validation of a Self-Determination Theory-Based Measure of Motivation to Exercise and Diet in Children

Objective: To develop and test the factorial structure of a new self-determination theory–based measure of behavioral regulation in children.

Methods: Five hundred ninety 590 (F = 51.7%) children aged 7 to 11 years completed the Motivation to Exercise and Diet (MED-C) questionnaire, which comprises 16 items (eight for exercise and eight for diet) grouped into eight factors (five motivations and three needs). Psychometric testing included confirmatory factor analysis and internal consistency. Measurement invariance analyses were also performed to evaluate whether the factorial structure of the MED-C was equivalent for gender (male vs. female), age (≤9 vs. ≥10 years), and the perception of having at least one parent with overweight or obesity (yes vs. no).

Results: Factorial analysis confirmed an acceptable factors solution for the MED-C and a good fit to the data for both the exercise and the diet subscales assessed independently. The maximal reliability coefficient revealed good reliability for the exercise and the diet subscales. Moreover, the MED-C factor structure was invariant across group comparisons.

Discussion: Findings support the construct validity and reliability of the MED-C. Therefore, it represents the first validated instrument simultaneously measuring motivational regulation and psychological need satisfaction in the context of children’s exercise and diet. Considering the goodness of these results, scale percentile ranks of the total score distribution as well as the z score and the T score were provided for clinical and research purposes.

Conclusion: The MED-C might support the understanding of motivations and needs of children with weight problems and assist their process of behavioral change in primary and secondary prevention programs. Psychological factors represent, in fact, potential targets for interventions to increase children’s motivation to exercise and diet.

Factors Influencing Parents' and Children's Misperception of Children's Weight Status: a Systematic Review of Current Research

PURPOSE OF REVIEW

Misperception of children's weight status is prevalent among parents and children themselves and may impact parents' and children's health behaviors. This study was conducted in order to provide a descriptive systematic review of research on factors influencing parents' and children's misperceptions of children's weight status published in the past 5 years.

RECENT FINDINGS

Factors studied most often in relation to parents' and children's misperception included children's weight status, gender, and age, as well as parents' weight status, parental education levels and socioeconomic status, and ethnicity. Most determinants that were found to have a significant influence on misperception in parents also did in children. The literature on misperception of children's weight status is extensive. Most determinants assessed in included studies were known determinants of childhood obesity. Further research should be directed toward better understanding the impact of weight status perception (whether it is accurate or not) on health behaviors and weight gain over time.

Is social exposure to obesity associated with weight status misperception? Assessing Australians ability to identify overweight and obesity

INTRODUCTION

Overweight and obesity prevalence has increased significantly over the past two decades, currently impacting greater than 60% of Australians. It is unclear if a social perception of a healthy weight has been obscured by the increase in prevalence and thus has become inconsistent with the medical definitions.

METHODS

An electronic questionnaire was distributed via email and social media using the authors' informal networks. Australian adults were eligible to participate. Participants were asked to categorise their own body size using medically accepted words and previously published silhouettes, before identifying underweight, healthy weight, overweight or obesity in a series ofsilhouettes.

RESULTS

Eight hundred six questionnaires were completed, a majority of participants had attained a high level of education and were employed female health professionals. Under half the studied population had a Body Mass Index (BMI) corresponding to overweight or obese categories (n = 349, 47%). Accuracy in self-perceived weight status using medicalised words was higher among respondents with BMI corresponding to the healthy weight category (n = 311, 85%) and overweight category (n = 133, 74%) than for respondents with BMI corresponding to obesity (n = 79, 45%) or underweight (n = 5, 31%). A majority of respondents were able to accurately self-perceive their weight status using silhouettes (n = 469, 70%). Females were significantly more likely to be accurate in their self-perception than males, using both medicalised words (p = < 0.001) and silhouettes (p = 0.045). Respondents with a BMI corresponding to the obese category were significantly more likely to be accurate with weight status self-perception using silhouettes than words (87% versus 46% respectively, p = < 0.001). Less than half (41%) of respondents accurately perceived silhouettes corresponding to an overweight BMI and less than one in ten respondents (9%) accurately perceived the lower limit of the silhouettes corresponding to an obese BMI.

CONCLUSIONS

Repondents were challenged to accurately perceive silhouettes corresponding to an obese BMI in themselves and others. Weight status misperception was more likely to exist among those with a BMI less than 18.5 or 30 or more (underweight BMI and obese BMI). Accuracy decreased as BMI increased. Respondents with a BMI in the obese category were significantly more likely to accurately self-perceive their weight status using silhouettes than medicalised words. Silhouettes may act as an effective visual cue in initiating weight related discussions.

Nurse-Led Telephone Follow-Up to Improve Parent Promotion of Healthy Behaviors in Young Children With Motivational Interviewing Techniques

INTRODUCTION

The American Academy of Pediatrics (AAP) recommends primary care-based health promotion for obesity prevention at all visits, focusing on nutrition and activity.

METHODS

In this quality improvement project, a primary care innovation was developed to support parents in promoting healthy habits in their children ages 2 to 5 years old. Nurse-led telephone support using motivational interviewing was implemented during two follow-up phone calls aimed at helping parent-child dyads reach self-created activity or nutrition goals.

RESULTS

Parent-rated confidence and motivation related to meeting these goals showed significant increases. During the second call, 80% self-reported goal completion and high satisfaction with the visits. Registered nurses reported a significant increase in their self-efficacy of communication with parents.

DISCUSSION

This project showed the feasibility of using nurse telephone visits in an urban low-income primary care setting to improve parental recognition and understanding of healthy habits that align with American Academy of Pediatrics recommendations for obesity prevention.

Does parental concern about their child's future risk of overweight vary by their ethnic background? Cross-sectional analysis of a national cohort study

OBJECTIVES

Children from South Asian ethnic backgrounds are at increased risk of obesity and its associated future health risks; however, evidence is lacking as to whether parental concern about their child's future overweight risk varies by ethnic background. We hypothesised that parents of 5-year-old children from South Asian backgrounds would be more likely to express such concerns.

DESIGN

Cross-sectional.

SETTING

UK.

PARTICIPANTS

15 039 singleton 5-year-old Millennium Cohort Study participants (48.9% girls; 86.7% White).

PRIMARY OUTCOME MEASURE

Parent-reported concern (some/none) about future overweight risk.

METHODS

We estimated the adjusted ORs (aORs) of some parental concern (ranging from a little to very concerned) by child's ethnic background (reference group: White), adjusted for parent and child weight status, and child sex.

RESULTS

Parents of girls from Pakistani (aOR 0.4; 95% CI 0.2 to 0.5), Bangladeshi (0.3; 0.2 to 0.5), Black African (0.5; 0.3 to 0.7) and Mixed (0.7; 0.5 to 0.99) ethnic backgrounds and of boys from Pakistani ethnic backgrounds (0.6; 0.4 to 0.9) were less likely to report concern about their child's future overweight risk than parents of White girls and boys, respectively. Overweight (2.5; 2.2 to 2.8) and obesity (6.7; 5.7 to 7.9) in children, and overweight (1.4; 1.2 to 1.5) and obesity (1.9; 1.7 to 2.2) in parents, were associated with increased likelihood of concern.

CONCLUSIONS

Parents of children from South Asian ethnic backgrounds express less concern about their child's future overweight risk. Qualitative studies are needed to understand the concerns of parents from different ethnic backgrounds to inform weight-management interventions in ethnically diverse populations.

Poor Performance of Children Age 7 to 13 Years on the Newest Vital Sign

Valid and reliable instruments are needed to assess health literacy in children. Although the Newest Vital Sign (NVS) has been well established for use in adults, reports of its use in children have only recently received attention in the literature. Whereas some researchers have reported successful use of the NVS in children as young as age 7 years, others have suggested it is best used in children age 10 years and older. This analysis reports on the performance of the NVS in children age 7 to 13 years, adding to the growing evidence related to the use of the NVS in pediatric populations. Overall, children in this sample performed poorly on the NVS, which refutes previous reports. Differences in child samples and NVS administration procedures may provide some explanation for the lower-than-anticipated NVS performance in this sample. Interpreting the NVS based on educational standards and expectations may provide additional information to determine age-appropriate recommendations for NVS use in children. [HLRP: Health Literacy Research and Practice. 2018;2(4):e175–e179.]

Prenatal Diet and Child Growth at 18 Months

OBJECTIVE

Our objective was to evaluate the effect of an antenatal dietary and lifestyle intervention in pregnant women who are overweight or obese on child outcomes at age 18 months.

METHODS

We conducted a follow-up study of children at 18 months of age who were born to women who participated in the Limiting Weight Gain in Overweight and Obese Women during Pregnancy to Improve Health Outcomes randomized trial. The primary follow-up study outcome was prevalence of child BMI z scores >85th percentile. Secondary study outcomes included a range of anthropometric measures, neurodevelopment, general health, and child feeding. Intention to treat principles were used in analyses, according to the treatment group allocated at randomization.

RESULTS

A total of 1602 children were assessed at age 18 months (lifestyle advice, n = 816; standard care, n = 786), representing 75.0% of the eligible sample (n = 2136). There were no statistically significant differences in the prevalence of child BMI z scores >85th percentile for children born to women in the lifestyle advice group, compared with the standard care group (lifestyle advice, 505 [47.11%] versus standard care, 483 [45.36%]; adjusted relative risk: 1.04; 95% confidence interval: 0.94 to 1.16; P = .45). There was no evidence of effects on child growth, adiposity, neurodevelopment, or dietary and physical activity patterns.

CONCLUSIONS

There is no evidence that providing pregnant women who were overweight or obese with an antenatal dietary and lifestyle intervention altered 18-month child growth and adiposity.